Outcome after operative treatment of Vancouver type B1 and C periprosthetic femoral fractures: open reduction and internal fixation versus revision arthroplasty

Laurer, Helmut; Wutzler, Sebastian; Possner, Susann; Geiger, Emanuel V.; Saman, Abdul; Marzi, Ingo; Frank, Johannes

doi:10.1007/s00402-011-1272-y

Cited by 54 publications

(32 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…All patients from both studies healed after the index procedure, with 1 patient having a delayed union and 1 with proximal screw loosening in the series by Xue et al These results compare favorably with the treatment of similar fractures using cortical onlay grafts alone, 3,50,53,60 where nonunion requiring revision surgery has been reported in 8%-10% of cases 3,50,60 and where angular malunion has been reported to occur in 5%-10% of cases. 6 61,62 It is important to recognize that in these series, all patients had bicortical fixation in the proximal fragment including bicortical locking screws anterior or posterior to the prosthesis, bicortical fixation into the lesser trochanter, or bicortical fixation into the greater trochanter, or some combination of these methods.…”

Section: Open Reduction and Internal Fixationmentioning

confidence: 99%

“…[4][5][6] The earlier weight bearing and improved mobilization associated with revision arthroplasty with implants that span the fracture may provide for improved mortality rates if patients who can withstand the magnitude of such surgery are properly selected. However, revision of an associated well-fixed stem to a long-stem modular prosthesis nail that spans the fracture has recently been advocated by several authors for Vancouver B fractures regardless of the stem stability.…”

Section: Revision Hip Arthroplastymentioning

confidence: 99%

See 1 more Smart Citation

Periprosthetic Femur Fractures

Ricci

2015

Journal of Orthopaedic Trauma

115

View full text Add to dashboard Cite

Successful treatment of periprosthetic femur fractures, like all fractures, requires careful attention to understand the fracture pattern nuances, identifying and executing a rational treatment approach, and providing an appropriate postoperative recovery protocol. Unlike most other fractures, modification of standard techniques is often required to obtain a stable fixation construct, and there is a greater role for revision arthroplasty in the treatment of periprosthetic fractures. Optimal indications for surgical repair versus revision arthroplasty and optimal postoperative weight-bearing protocols remain uncertain. Reported outcomes for patients with periprosthetic femoral shaft fractures are generally good and are relatively consistent. Results for periprosthetic distal femur fractures, however, are less good and more inconsistent. Both periprosthetic femoral shaft and distal femur fractures are associated with relatively high mortality rates, approaching that of patients with hip fractures. This review should provide insight into the current solutions and challenges for the treatment of patients with periprosthetic femur fractures.

show abstract

Section: Open Reduction and Internal Fixationmentioning

confidence: 99%

Section: Revision Hip Arthroplastymentioning

confidence: 99%

Periprosthetic Femur Fractures

Ricci

2015

Journal of Orthopaedic Trauma

115

View full text Add to dashboard Cite

show abstract

“…The postoperative period is also challenging for patients, given the burden of medical co-morbidities in this population, as well as the frequent need for extended periods of protected weightbearing [5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Management of periprosthetic femoral fractures following total hip arthroplasty: a review

Abdel

Cottino

Mabry

2015

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Periprosthetic femoral fractures after primary total hip arthroplasty are a complex and clinically challenging issue. The treatment must be based on the fracture, the prosthesis, and the patient (Table 1). The Vancouver classification is not only helpful in classifying the fractures, but also in guiding the treatment. In general, well-fixed stems require open reduction and internal fixation, whereas loose stems require revision arthroplasty.

show abstract

“…Although fixation by a locking plate alone was reported to have limitations, and addition of a cable or wire was recommended in some recent reports,15,16,25) type B1 and C fractures are currently becoming widely treated by locking plate systems. We treated all of our type B1 and C fractures by osteosynthesis using a locking plate system, except of one case with a non-displaced type C fracture and the clinical results were satisfactory.…”

Section: Discussionmentioning

confidence: 99%

Treatment Results of a Periprosthetic Femoral Fracture Case Series: Treatment Method for Vancouver Type B2 Fractures Can Be Customized

et al. 2014

View full text Add to dashboard Cite

BackgroundCurrently, an algorithmic approach for deciding treatment options according to the Vancouver classification is widely used for treatment of periprosthetic femoral fractures after hip arthroplasty. However, this treatment algorithm based on the Vancouver classification lacks consideration of patient physiology and surgeon's experience (judgment), which are also important for deciding treatment options. The purpose of this study was to assess the treatment results and discuss the treatment options using a case series.MethodsEighteen consecutive cases with periprosthetic femoral fractures after total hip arthroplasty and hemiarthroplasty were retrospectively reviewed. A locking compression plate system was used for osteosynthesis during the study period. The fracture type was determined by the Vancouver classification. The treatment algorithm based on the Vancouver classification was generally applied, but was modified in some cases according to the surgeon's judgment. The reasons for modification of the treatment algorithm were investigated. Mobility status, ambulatory status, and social status were assessed before the fracture and at the latest follow-up. Radiological results including bony union and stem stability were also evaluated.ResultsThirteen cases were treated by osteosynthesis, two by revision arthroplasty and three by conservative treatment. Four cases of type B2 fractures with a loose stem, in which revision arthroplasty is recommended according to the Vancouver classification, were treated by other options. Of these, three were treated by osteosynthesis and one was treated conservatively. The reasons why the three cases were treated by osteosynthesis were technical difficulty associated with performance of revision arthroplasty owing to severe central migration of an Austin-Moore implant in one case and subsequent severe hip contracture and low activity in two cases. The reasons for the conservative treatment in the remaining case were low activity, low-grade pain, previous wiring around the fracture and light weight. All patients obtained primary bony union and almost fully regained their prior activities.ConclusionsWe suggest reaching a decision regarding treatment methods of periprosthetic femoral fractures by following the algorithmic approach of the Vancouver classification in addition to the assessment of each patient's hip joint pathology, physical status and activity, especially for type B2 fractures. The customized treatments demonstrated favorable overall results.

show abstract

Outcome after operative treatment of Vancouver type B1 and C periprosthetic femoral fractures: open reduction and internal fixation versus revision arthroplasty

Abstract: The use of angular stable implants, additional cable wires or bone enhancing means is recommended.

Cited by 54 publications

References 16 publications

Periprosthetic Femur Fractures

Periprosthetic Femur Fractures

Management of periprosthetic femoral fractures following total hip arthroplasty: a review

Treatment Results of a Periprosthetic Femoral Fracture Case Series: Treatment Method for Vancouver Type B2 Fractures Can Be Customized

Contact Info

Product

Resources

About